输尿管上段结石经输尿管镜碎石失败66例再治疗经验

目的总结输尿管上段结石输尿管镜下碎石失败者再治疗经验。方法2004年2月-2006年9月，66例输尿管镜下碎石治疗输尿管上段结石失败患者，包括因结石下段输尿管扭曲，结石下方输尿管炎性狭窄、肉芽组织形成或包裹结石致输尿管镜下未见结石40例，碎石时结石漂人肾盂26例，改行微创经皮肾镜取石术（M—PCNL）或体外冲击波碎石（ESWL）。结果48例直接改行M—PCNL，均一次将结石完全取净；18例留置双J管1周后行1—4次ESWL后联合药物排石，1个月后拔除双J管，复查KUB、B超，14例结石完全排净，4例结石未击碎排净改行M—PCNL，均一次将残余结石完全取净。术中、术后未出现严重并发症。结论M—PCNL取石损伤小，结石清除率高，是输尿管镜下输尿管上段结石碎石失败的有效微创治疗方法。

Retreatment Experience of Unsuccessfully Ureteroscopic Lithotripsy for Upper Ureteral Calculi: A Report of 66 cases

Objective To summarize the therapeutic experience of unsuccessful ureteroscopic lithotripsy for upper ureteral calculi.Methods From February 2004 to September 2006,66 cases of upper ureteral calculi were retreated by minimally percutaneous nephrolithotripsy(M-PCNL) or extracorporeal shock wave lithotripsy(ESWL) due to failure of ureteroscopic lithotripsy,including 40 cases of lower ureter distortion induced by calculi,ureter inflammation stenosis below calculi,undetected calculi encapsulated by granulation tissue under ureteroscope,and 26 cases of calculi drift to pelvis during lithotripsy.Results 48 cases were conducted by M-PCNL directly,with calculi removed thoroughly in a single operation.18 cases were placed double J tubes,and then managed by 1-4 times ESWL combined with drugs 1 week later;double J tubes were taken out after one month;KUB and B ultrasonography showed that calculi were cleared fully in 14 cases,and other 4 cases whose calculus could not be broken and removed were converted to M-PCNL,with residual calculus cleared thoroughly in a single operation.No perioperative severe complications occurred.Conclusions M-PCNL is an effective procedure to unsuccessful ureteroscopic lithotripsy for upper ureteral calculi,with minimal invasion and higher clearance rate of calculi.